COLONIC J-POUCH AS A NEORECTUM - FUNCTIONAL ASSESSMENT

Background: Sphincter-saving procedures are now commonly used for low rectal cancer but straight colo-anal anastomosis seemed to produce poo r functional outcome. The present study was therefore carried out to c ompare and contrast the functional outcome of colonic J-pouch and stra ight cole-anal anastomosis. Methods: The clinical and functional outco me of 17 patients having a colonic J-pouch-anal anastomosis and 10 pat ients having a straight cole-anal anastomosis were compared. They were compared in terms of age, sex, distal resection margin, Dukes stage, histological grade, morbidity/mortality and postoperative anal functio n. Results: There was better bowel function in patients having J-pouch -anal anastomosis, especially in the early period after closure of the covering stoma. Bowel frequency in those patients who had a J-pouch a nastomosis was much less compared to those patients in the straight co le-anal group in the 1st and possibly the 2nd year. There was a period of adaptation for the straight cole-anal group which led to a bowel f requency approaching that of the J-pouch group over 1-2 years. Differe nces in urgency, faecal continence, evacuation function, the use of dr ugs to slow bowel frequency and ability to discriminate between flatus and faeces were found to favour the J-pouch group in the first postop erative year. The difference between the two groups diminished after t hat because the straight group improved, especially by the end of the 2nd year. During the study period, there were no constipation problems in the J-pouch group. as noted in some other studies. This was probab ly associated with the 6-cm length chosen for the pouch. Conclusions: The use of colonic J-pouch resulted in a significant decrease in stool frequency and more satisfactory anal function for the first postopera tive year. This difference lessened during the second postoperative ye ar. There was no demonstrable difficulty with rectal evacuation in the pouch patients.